Rotational Atherectomy Versus Balloon Pre-dilated For Treating Heavily Calcified Coronary Lesions

ObjectiveCoronary artrey calcium(CAC)is a serious challenge during the percutaneous coronary intervention(PCI).Calcified plaques could lead to failure in delivery of the device or incomplete expansion of the stents,as well as the drug-eluting stent(DES)was damaged during the operation.Subsequently in-stent restenosis and thrombosis would be occurred.Rotational atherectomy(RA)could remove calcified plaques,improve the success rate of device delivery,and become an effective method for stent implantation.This article mainly discusses the differences between RA and conventional balloon pre-expansion in the treatment of coronary artery severe calcified lesions,to guide the clinical choice of treatment options for CAC lesions.MethodsWith the approval of the ethics committee of our hospital,a prospective randomized controlled study of clinical information was included in patients with severe CAC disease who underwent PCI treatment at Fuyang People's Hospital from October 2017 to October 2018.Coronary angiography(CAG)was used to select patients and scored SYNTAX,who suffered from severe calcified coronary artery lesions.For the score of the cases were 23 to 32,RA combined with DES(observation group)or balloon pre-dilated combined with DES(control group)was randomly selected.The baseline data,vascular lesion characteristics,the success rate of surgery,postoperative complications,as well as MACCE during hospitalization and follow-up were compared between the two groups.To compare the difference between the therapeutic effect of RA or balloon pre-dilated combined with DES on severe CAC.Logistic regression analysis was used to find out the risk factors that affected the short-term MACCE after operation,analyze the risk factors in different cases,and guide the clinical choice of treatment options for CAC lesions.Results1.There were no significant statistical difference in gender,age,body mass index,smoking,previous disease history,blood biochemical examination,postoperative myocardial markers,and cardiac function between the two groups(P>0.05)There were no significant differences in B2 / C type lesions,SYNTAX scores,and treatment pathways(P>0.05).2.There were no significant statistical difference in the number of guidewires,stent numbers,and total stent length used in the two groups of patients(P>0.05).The average stent diameter was significantly higher in the observation group than in the control group(P=0.002).The number of balloon pre-dilated,pre-dilated maximum pressure,the number of balloon post-dilated and post-dilated maximum pressure were lower in the observation group(P<0.05).There was no significant statistical difference in the lumen diameter of the target vessels before surgery between the two groups(P>0.05),but the lumen diameter of the postoperative was larger in the observation group than the control group(P = 0.005).There were no significant statistical difference in surgical time and radiation time between the two groups(P>0.05),and the amount of contrast agent in the observation group was less than the control group(P = 0.007).3.The immediate success rates of this surgery in the two groups were 96.9% and 92.5%,respectively,with no significant difference(P > 0.05).There was no significant statistical difference in operative complications(P>0.05),which 4 cases(12.5%)of the observation group and 6 cases(15.0%)of the control group occurred.No serious complications occurred in both groups,such as coronary dissection,coronary perforation and cardiac tamponade.4.The incidence of MACCE during hospitalization and follow-up of the two groups was 22.5% vs.9.4%,comparison using Kaplan-Meier curve showed no significant statistical difference(P = 0.130).Screen out variables that might affect MACCE within 6 months of the patient(P<0.05),including the previous PCI,postoperative CK-MB,whether to perform RA,the number of balloon pre-dilated,pre-dilated maximum pressure,and contrast agent dosage.All the variables were included in logistic regression analysis,and the results showed that the previous PCI(RR was 1.155,95% CI 0.030?0.691,P = 0.015)and the balloon pre-dilated maximum pressure(RR was 2.326,95% CI 0.721?0.988,P = 0.035),were independent risk factors for MACCE within 6 months.ConclusionFor coronary arterial severe calcification whether to choose RA didn't reduce the incidence of MACCE.The previous PCI and the maximum pressure of balloon pre-dilated were independent risk factors for MACCE within 6 months.RA has the tendency to improve the procedural success rate and reduce short-term adverse events.